Dr. Ulrike Kaunzner was the first author on a paper that has been published under the leadership of Dr. Susan Gauthier in the journal “Brain”, that combined two imaging techniques to shed better light on the presence of chronic active lesions in MS patients.
Chronic or old MS lesions can be separated into chronic inactive and chronic active lesions. Chronic inactive lesions are scars that are not changing over time. Chronic active lesions are characterized by the presence of activated microglia cells, which are immune cell found in the brain. These cells carry iron and can cause continued myelin and nerve loss in patients with MS. Until recently, there was no MRI method to distinguish lesions with more inflammation from inactive scars. Therefore, our goal was to determine if we could identify chronic active lesions with a new MRI method called QSM (quantitative susceptibility mapping). This MRI method was developed at Weill-Cornell by Dr. Yi Wang, a physicist in the Department of Radiology, and can be used to detect iron in MS lesions. We further used PET scans, which can detect microglia cells, to confirm that the iron in the lesions correlated with inflammation. We studied lesions in 30 MS patients and found that 10 percent of lesions had iron and more importantly, those lesions with iron had much higher inflammation on PET. The novelty of using PET in this study is that it allowed us to provide evidence that QSM can identify chronic active lesions in a broad MS population. In addition, we collaborated with Dr. David Pitt, from Yale University, to confirm our results using MS lesions from a brain donation repository. Our results confirmed that QSM MRI can detect chronic active MS lesions in patients with MS.
The importance of our study is two-fold. First, we found that QSM MRI can identify a subset of chronic lesions that continue to cause damage and may play an essential role in disease progression. Secondly, we are identifying a potentially new lesion target for novel treatment strategies that may benefit both relapsing remitting and progressive MS patients.
By Ulrike Kaunzner, MD, PhD
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